Doctor Name: | GINA M WAGNER |
NPI Number: | 1144663931 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | DPT |
License Number: | 11964-24 |
Business Practice Address: | 3800 Park Nicollet Blvd Rehabilitation Services Saint Louis Park, MN - 554162527 |
Business Phone Number: | 9529930973 |
Business Fax Number: | |
Mailing Address: | 3124 Jersey Ave S, SAINT LOUIS PARK |
State: | MN |
Postal Code: | 554263443 |
Phone Number: | 6086304872 |
Fax Number: | |
NPI Enumeration Date: | 04/10/2013 |
NPI Last Update Date: | 08/01/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 11964-24 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | WI |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |